Healthcare Provider Details

I. General information

NPI: 1114394897
Provider Name (Legal Business Name): MEDICAL SPECIALTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 N MERIDIAN ST
INDIANAPOLIS IN
46208-5729
US

IV. Provider business mailing address

7320 E 82ND ST
INDIANAPOLIS IN
46256-1458
US

V. Phone/Fax

Practice location:
  • Phone: 317-842-5771
  • Fax: 317-576-1394
Mailing address:
  • Phone: 317-842-5771
  • Fax: 317-576-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. HAMID ABBASPOUR
Title or Position: PRESIDENT
Credential: RPH
Phone: 317-842-5771